HomeMy WebLinkAbout2300 Silver Trails Dr - Applications/Reroof - 03/05/2013City of
� Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # b 9 -7
For ofce use only
Date S / S / 1 --2;,
Job Site Address (required)
Value of Construction (labor, materials, profit)
23Gb S'(Je'r -DT
CID
-11 _W_r z�;�6`lfa
Property Owner Name
Address
City/State Zip Phone q1D
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2_ Do s,l,�
l �7k c lt1 CD &0526 531-9g04
Applicant Name
Address
City/State Zip Phone 9-to
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LA FaQok Co qN2S LiRO- 6,13
Contractor
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? A Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes I<NO
5202L
Is this a residential or commercial project? WResidential ❑ Commercial
If residential, is it: KSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ,�v No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Descri tion of wor f � Ren rye of -t- d L,� �
ea n O
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. , /\ -
Applicant:
Print Name: yi� rS k( signature
0�
Date S S tis _